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INTERESTING IMAGE
Year : 2020  |  Volume : 35  |  Issue : 2  |  Page : 172-173  

Herniated urinary bladder detected on18F-fluorodeoxyglucose positron-emission tomography/computed tomography scan imitating as18F-fluorodeoxyglucose avid lesion


Department of Nuclear Medicine and PET/CT, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India

Date of Submission12-Jan-2020
Date of Acceptance16-Jan-2020
Date of Web Publication12-Mar-2020

Correspondence Address:
Dr. Nitin Gupta
Department of Nuclear Medicine and PET/CT, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi - 110 060
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_7_20

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   Abstract 


Inguinal hernia is a common pathology seen in the general population. However, the presence of herniated urinary bladder in the inguinal canal is a rare condition. Most cases are asymptomatic and are detected incidentally either during surgery or on imaging. Here, we present a report, where a patient, diagnosed case of carcinoma esophagus, was referred for staging18F-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG PET/CT) scan and revealed FDG uptake in the right inguinal canal, other than primary and metastatic lesions and corresponding CT and fused PET/CT images revealed herniated urinary bladder in the inguinal canal.

Keywords: 18FDG PET-CT scan, inguinal hernia, urinary bladder


How to cite this article:
Gupta N, Verma R, Belho ES. Herniated urinary bladder detected on18F-fluorodeoxyglucose positron-emission tomography/computed tomography scan imitating as18F-fluorodeoxyglucose avid lesion. Indian J Nucl Med 2020;35:172-3

How to cite this URL:
Gupta N, Verma R, Belho ES. Herniated urinary bladder detected on18F-fluorodeoxyglucose positron-emission tomography/computed tomography scan imitating as18F-fluorodeoxyglucose avid lesion. Indian J Nucl Med [serial online] 2020 [cited 2020 Jul 14];35:172-3. Available from: http://www.ijnm.in/text.asp?2020/35/2/172/280460



A 55-year-old male patient, recently diagnosed case of carcinoma esophagus, was referred for staging 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG PET/CT) scan. MIP image [Figure 1]a showed few foci of FDG uptake in whole body. FDG-avid primary lesion [Figure 1]b, [Figure 1]c, [Figure 1]d was localized in the distal esophagus and FDG-avid metastatic lesions were appreciated in the right lung and liver. Apart from these, a large lobulated FDG-avid focus was visualized in the right inguinal region. On correlating with corresponding CT and fused PET/CT axial and sagittal views [Figure 1]e, [Figure 1]f, [Figure 1]g, [Figure 1]h, [Figure 1]i, [Figure 1]j, the FDG avid focus in the right inguinal region was found to be of fluid density on CT, continuous with the urinary bladder, thus confirming the FDG uptake as the herniated urinary bladder in the right inguinal canal.
Figure 1: Maximum intensity projection (a) of whole-body18F-fluorodeoxyglucose positron-emission tomography/computed tomography scan showing18F-fluorodeoxyglucose uptake in the right inguinal canal in addition to18F-fluorodeoxyglucose-avid lesions in primary and metastatic sites. Axial fused positron-emission tomography/computed tomography (b), computed tomography (c), and positron-emission tomography (d) images showing18F-fluorodeoxyglucose-avid lesion in distal esophagus, corresponding to the known primary site.18F-fluorodeoxyglucose uptake in the right inguinal canal (g and j) localises to herniated urinary bladder as seen in fused positron-emission tomography/computed tomography axial (e) sagittal (h) and computed tomography axial (f) and sagittal (i) images

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Bladder hernia represents 0.5%–3% of all lower abdominal hernias[1] and 1%–3% of cases of all inguinal hernias[2] and is observed in obese men between the ages of 50 and 70 years. Most of these hernias are direct and seen in the right side[3] as seen in our case. The possible reasons of bladder hernias are bladder neck obstruction due to prostatic hypertrophy, reduced bladder tone, weak pelvic muscles, and obesity.[4] Most cases are asymptomatic and are detected incidentally. Less than 7% of bladder hernias are diagnosed preoperatively.[5]

In normal individuals, intense FDG uptake is observed in the kidneys, ureters, and bladders because of normal urinary excretion. The differential diagnosis of FDG uptake in the inguinal canal includes testicular cancer, inflammation and urine skin contamination artifact, metastatic lymph nodes, hernia with bowel loops as contents, and inguinal herniation of the urinary bladder. Few reports have been published previously of incidentally detected herniated urinary bladder on CT[6] and on PET/CT scan[7],[8],[9],[10].

Here, we report an interesting case of a rare finding of incidentally detected herniated urinary bladder and also highlight the importance of keeping differentials in mind of FDG uptake in the inguinal canal and correlating axial, coronal, and sagittal images and PET image with fused PET/CT and CT images.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Conde Sánchez JM, Espinosa Olmedo J, Salazar Murillo R, Vega Toro P, Amaya Gutiérrez J, Alonso Flores J, et al. Giant inguino-scrotal hernia of the bladder. Clinical case and review of the literature. Actas Urol Esp 2001;25:315-9.  Back to cited text no. 1
    
2.
Curry NS. Hernias of the urinary tract. In: Pollack HM, McClennan BL, editors. Clinical Urography. 3rd ed. Philadelphia, PA: Saunders; 2000. p. 2981-91.  Back to cited text no. 2
    
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Oruç MT, Akbulut Z, Ozozan O, Coşkun F. Urological findings in inguinal hernias: A case report and review of the literature. Hernia 2004;8:76-9.  Back to cited text no. 3
    
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Bisharat M, O'Donnell ME, Thompson T, MacKenzie N, Kirkpatrick D, Spence RA, et al. Complications of inguinoscrotal bladder hernias: A case series. Hernia 2009;13:81-4.  Back to cited text no. 4
    
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Kraft KH, Sweeney S, Fink AS, Ritenour CW, Issa MM. Inguinoscrotal bladder hernias: Report of a series and review of the literature. Can Urol Assoc J 2008;2:619-23.  Back to cited text no. 5
    
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Gunduz Y, Ayhan Tatli L, Asil K, Ersel Aksoy Y. A rare cause of inguinal herniation: Bladder herniation two cases report. J Med Cases 2013;4:588-90.  Back to cited text no. 6
    
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Aygen M, Akduman IE, Osman MM. Bladder ear: A potential source of false interpretation on F-18 FDG PET. Clin Nucl Med 2008;33:721-2.  Back to cited text no. 7
    
8.
Harisankar CN. Incidentally detected vesico inguinal hernia on fluoro-deoxy glucose positron emission tomography-computed tomography. Indian J Nucl Med 2013;28:127-8.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Hinojosa D, Joseph UA, Wan DQ, Barron BJ. Inguinal herniation of a bladder diverticulum on PET/CT and associated complications. Clin Imaging 2008;32:483-6.  Back to cited text no. 9
    
10.
Vadi SK, Mittal BR, Singh H, Kumar R, Dhiman RK. incidental detection of urinary bladder herniation in 18F-fluorodeoxyglucose positron emission tomography/computed tomography mimicking as metastatic deposit in the inguinal canal. Indian J Nucl Med 2019;34:247-8.  Back to cited text no. 10
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